CurrentCulinary Health FundPolicy N/A

Patient Financial Responsibility for Transesophageal Echocardiogram (TEE) Procedures

This notice explains member cost-sharing for TEE procedures performed in the hospital outpatient setting and is directed to hospital outpatient admissions and insurance verification staff who handle Culinary Health Fund members.

Policy Summary

PayerCulinary Health Fund

PolicyPatient Financial Responsibility for Transesophageal Echocardiogram (TEE) Procedures

Policy CodePolicy N/A

Change TypeNotice — no material changes

Effective DateJun 18, 2012

Next Review DateN/A

Key ActionNotify admissions and insurance verification staff of the $75 copay plus 20% coinsurance for outpatient TEE procedures and direct questions to Customer Service at (702) 733-9938.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$75member co-pay for outpatient TEE

20%member co-insurance on allowable charges

80%portion paid by Culinary Health Fund

Outpatient TEE Cost-Sharing

Outpatient TEE cost-sharing

For Culinary Health Fund members receiving a TEE in the outpatient hospital setting:

Member is responsible for a $75.00 copay plus 20% coinsurance on allowable charges; Culinary Health Fund pays the remaining 80%.

Procedure Coding and Cost Details

Procedure coding not specifiedmixed

No codes listed

Cost-share thresholds for outpatient TEE

Member cost-share$75.00 copay plus 20% coinsurance on allowable charges; Culinary Health Fund pays remaining 80%.

ApplicabilityApplies when a Culinary Health Fund member has a TEE in the outpatient hospital setting.

Patient responsibility summary

Policy Summary

PayerCulinary Health Fund

PolicyPatient Financial Responsibility for Transesophageal Echocardiogram (TEE) Procedures

Policy CodePolicy N/A

Change TypeNotice — no material changes

Effective DateJun 18, 2012

Next Review DateN/A

Key ActionNotify admissions and insurance verification staff of the $75 copay plus 20% coinsurance for outpatient TEE procedures and direct questions to Customer Service at (702) 733-9938.

SourceLink

On This Page

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Notifications and Contact

Note

Provider notification and contact — notify admissions, insurance verification representatives, and other affected staff of member cost-sharing for outpatient TEE procedures.

When a Culinary Health Fund member has a transesophageal echocardiogram (TEE) in the outpatient hospital setting, the member is responsible for a $75.00 co-pay plus 20% co-insurance on allowable charges; Culinary Health Fund pays the remaining 80%. Notify all admissions staff, insurance verification representatives, and other affected personnel of this member cost-sharing requirement for outpatient TEE procedures. For questions or additional information, contact Culinary Health Fund Customer Service at (702) 733-9938.

Member cost-sharing for outpatient TEE: $75.00 co-pay + 20% co-insurance on allowable charges (Fund pays 80%)
Notify admissions, insurance verification representatives, and other affected staff of the co-pay and coinsurance for outpatient TEE procedures
Provide Customer Service contact for questions: (702) 733-9938

OpenPayer

Patient Financial Responsibility for Transesophageal Echocardiogram (TEE) Procedures

Outpatient TEE Cost-Sharing

Procedure Coding and Cost Details

Notifications and Contact

Scope and Setting Definitions